Edinburgh Napier University

  Background
Primary care services in the UK are encountering unprecedented challenges, including staffing shortages, rising costs and workloads, and policy initiatives supporting high-quality person-centred care. To meet these demands and the complex needs of communities, the NHS has undergone many reforms over the last three decades. One of the key reforms is the expansion of prescribing to non-medical professionals (NMP), with nurses being the core group within the primary care setting. However, the uptake of this extended role has been slow despite its many advantages.

Aim
The aim of this review was to identify, examine, and synthesise qualitative research that has explored nurse independent prescribers’ (NIPs) views and experiences of their prescribing practice in the primary care setting. More specifically, the objectives were to gain personal insights into prescribing decision-making from the perspective of NIPs and thus identify the factors influencing appropriate practice.

Methods
A systematic review and thematic synthesis were carried out to bring together and integrate the findings of multiple qualitative studies. Six electronic databases, including MEDLINE, CINAHL, PsycInfo, PsycArticles, Web of Science and Google Scholar were systematically searched for qualitative research between November and December 2022. The identified studies were checked against the eligibility criteria using the SPIDER tool. Quality appraisal was carried out using the CASP tool.

Results
Twelve studies published between 1998 and 2019 reporting experiences of 209 NIPs practising across primary care were synthesised. Thematic synthesis revealed two overarching themes: barriers (e.g., insufficient training, increased workload) and enablers (e.g., peer support, good knowledge of pharmacology) to NIP practice, which were further organised into sub-themes.

Discussion
NIPs were mostly positive in their reflections on their prescribing role, particularly the impact on healthcare practice that nurse independent prescribing had on their patients, with timely access to medications and improved patient experience. The review also found that patient expectations could create opportunities for the provision of patient education, thus increasing autonomy and job satisfaction for NIPs.

Conclusions
Factors influencing NIPs’ practice are interrelated. Future strategies to promote higher uptake of prescribing qualifications must consider the importance of improved patient outcomes and increased job satisfaction. Further research is required to identify the factors affecting other NMPs beyond nursing groups.